Emergency preparedness and public health systems lessons for developing countries

Low- and middle-income countries, where emerging diseases often make their debut, are also likely to bear the harshest consequences of a potential influenza pandemic. Yet public health systems in developing countries are underfunded, understaffed, and in many cases struggling to deal with the existing burden of disease. As a result, developed countries are beginning to expand assistance for emergency preparedness to the developing world. Given developing countries' weak infrastructure and many competing public health priorities, it is not clear how to best direct these resources. Evidence from the U.S. and other developed countries suggests that some investments in bioterror and pandemic emergency preparedness, although initially implemented as vertical programs, have the potential to strengthen the general public health infrastructure. This experience may hold some lessons for how global funds for emergency preparedness could be invested in developing countries to support struggling public health systems in responding to current health priorities as well as potential future public health threats.     

Terrorism and emergency preparedness in state and territorial public health departments--United States, 2004

After the events of September 11, 2001, federal funding for state public health preparedness programs increased from $67 million in fiscal year (FY) 2001 to approximately $1 billion in FY 2002. These funds were intended to support preparedness for and response to terrorism, infectious disease outbreaks, and other public health threats and emergencies. The Council of State and Territorial Epidemiologists (CSTE) assessed the impact of funding on epidemiologic capacity, including terrorism preparedness and response, in state health departments in November 2001 and again in May 2004, after distribution of an additional $1 billion in FY 2003. This report describes the results of those assessments, which indicated that increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level. However, despite the increase in epidemiologists, state public health officials estimate that 192 additional epidemiologists, an increase of 45.3%, are needed nationwide to fully staff terrorism preparedness programs.     

Student leadership in public health advocacy: lessons learned from the hepatitis B initiative

Increasing hepatitis B vaccination rates for Asian Americans and Pacific Islanders is a priority. Laws requiring vaccination prior to school enrollment have helped, yet many youths remain unvaccinated. The Hepatitis B Initiative (HBI), launched in 1997 and operated by public health and medical school students, provides free screenings and vaccinations to Boston's Asian American/Pacific Islander community, with a focus on youths. By October 2002, 997 HBI patients from Boston's Chinatown had received free hepatitis B screenings. Of these, 384 patients (39%) were deemed susceptible to the hepatitis B virus and provided with free vaccination.     

Tracking process and outcome results of BSW students' preparation for public child welfare practice: lessons learned

A Texas university/agency partnership program to prepare social work students for public child welfare conducted an exploratory study of the process and outcome results of the program's efforts from 1989-99 and offers recommendations to other university/agency programs. The evaluation plan was multi-faceted, and the evaluation included both process and outcome components from the perspectives of each stakeholder-the agency, the university, the students, the clients, and the taxpayers. The paper concludes with recommendations for the future. The partnership acknowledges that these evaluation results have limitations and are not generalizable beyond this specific partnership. The lessons learned in this university/agency partnership are first steps in developing better partnerships to prepare students for public child welfare practice.     

Emergency preparedness: the best defense for major disasters

This article discusses how Silver Cross Hospital in Joliet, Illinois developed its disaster plan and how that plan was successfully tested when a tornado plowed through its service area, causing mass casualties who required both inpatient and outpatient care.     

Skin cancer prevention: the problem, responses, and lessons learned.

Skin cancer is one of the most common forms of cancer and has rapidly increased during the past three decades in the United States. More than 1 million new cases of skin cancer are estimated to be diagnosed in the United States each year. The National Skin Cancer Prevention Education Program (NSCPEP) was launched by the Centers for Disease Control and Prevention (CDC) in 1994 as a national effort to address the Healthy People 2000 objectives for skin cancer prevention. The NSCPEP is a comprehensive, multidimensional public health approach that includes (1) primary prevention interventions; (2) coalition and partnership development; (3) health communications and education; and (4) surveillance, research, and evaluation. In 1994, through support from the CDC, state health departments in Arizona, California, Georgia, Hawaii, and Massachusetts initiated primary prevention intervention projects to conduct and evaluate skin cancer prevention education. This article discusses the comprehensive, multidimensional public health approach highlighting examples from the state demonstration projects.     

Multi-resistant infections in repatriated patients after natural disasters: lessons learned from the 2004 tsunami for hospital infection control

Infections are a frequent consequence of natural disasters. Repatriated victims may require hospital care due to multiple fractures, pneumonia or wound infections caused by multi-resistant pathogens that require specific infection control measures. To address potential pitfalls of infection control and clinical care in repatriated patients, we sought to provide microbiological insight into the possible origins of multi-drug antibiotic resistance in survivors of natural disasters. A review of the medical literature was performed from 1986 to 2006 with an emphasis on the 2004 tsunami disaster in the Indian Ocean. After natural disasters, polymicrobial infections may occur following heavy inoculation during trauma. Multi-resistant Gram-negative pathogens are more prevalent than Gram-positive bacteria. A high incidence of extended spectrum beta-lactamase-producing bacteria and difficult-to-treat fungal infections in otherwise immunocompetent hosts may challenge routine hospital care. We recommend that survivors of natural disasters should be kept in pre-emptive contact isolation during air transport and hospitalisation until the results of all microbiological cultures become available. A meticulous diagnostic work-up is necessary upon admission and empiric antibiotic treatment should be avoided. Infections may also become manifest after several weeks of hospitalisation. In case of life-threatening infection, antibiotic therapy should cover non-fermenting pathogens.     

Preparing for the unknown, responding to the known: communities and public health preparedness

More than four years after September 11, 2001, bioterrorism preparedness remains a high priority for federal, state, and local governments. With reasonably flexible federal funding, communities have strengthened their ability to respond to public health emergencies, according to assessments by stakeholders and market observers. Collaborative relationships developed for bioterrorism preparedness have proved useful in addressing other threats, such as natural disasters and infectious disease outbreaks. Major ongoing challenges include funding constraints, inadequate surge capacity, public health workforce shortages, competing priorities, and jurisdictional issues.     

Partnering for preparedness: the project public health ready experience

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The project's pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.     

Evaluating workforce development: perspectives, processes, and lessons learned.

Evaluating workforce development for public health is a high priority for federal funders, public health agencies, trainees, trainers, and academic researchers. But each of these stakeholders has a different set of interests. Thus, the evolving science of training evaluation in the public health sector is being pulled simultaneously in a number of different directions, each emphasizing different methods, indicators, data-collection instruments, and reporting priorities. We pilot-tested the evaluation of a 30-hour, competency-based training course in a large urban health department. The evaluation processes included strategic, baseline assessment of organizational capacity by the agency; demographic data on trainees as required by the funder; a pre- and posttraining inventory of beliefs and attitudes followed by a posttraining trainee satisfaction survey as required by the trainers and the agency; and a 9-month posttraining follow-up survey and discussion of learning usefulness and organizational impact as desired by the academic researchers and the trainers. Routinely requiring all of these processes in training programs would be overly burdensome, time-consuming, and expensive. This pilot experience offers some important practical lessons for training evaluations in the future.     

Stress, coping and lessons learned from the SARS outbreak

Talking about stress implies that we are talking about two things: an event and a response to that event. The 2003 SARS outbreak was an extraordinary event in the life of Ontario hospitals, especially around Toronto, and in the lives of the healthcare workers.     

Emergency medical consequence planning and management for national special security events after September 11: Boston 2004

The post-September 11 era has prompted unprecedented attention to medical preparations for national special security events (NSSE), requiring extraordinary planning and coordination among federal, state, and local agencies. For an NSSE, the US Secret Service (USSS) serves as the lead agency for all security operations and coordinates with relevant partners to provide for the safety and welfare of participants. For the 2004 Democratic National Convention (DNC), designated an NSSE, the USSS tasked the Boston Emergency Medical Services (BEMS) of the Boston Public Health Commission with the design and implementation of health services related to the Convention. In this article, we describe the planning and development of BEMS' robust 2004 DNC Medical Consequence Management Plan, addressing the following activities: public health surveillance, on-site medical care, surge capacity in the event of a mass casualty incident, and management of federal response assets. Lessons learned from enhanced medical planning for the 2004 DNC may serve as an effective model for future mass gathering events.     

International health services management education: an overview of major efforts and lessons learned during the 1990s

In this paper, the authors examine select major pedagogical and methodological issues concerning health care management executive training and academic program development in the former Soviet sphere of influence during the 1990s. Experience from programs offered during the 1990s has direct implications for the continued development of health care management programs and faculty in the United States. In essence, each of the nations that were involved represented an experimental setting for the introduction and improvement of management skills in the health care sector and the development of professional health care managers. Evaluative findings should help to inform future efforts to construct and deliver effective international and domestic management educational programs.     

Sustainability of the impact of a public health intervention: lessons learned from the laval walking clubs experience

To inform health promotion practice regarding the sustainability of public health interventions, the authors interviewed the directors of 13 new community-based organizations created through a practitioner-initiated public health intervention designed to promote physical activity at the community level. The purpose of the interviews was to uncover the factors that lead organization directors to become involved in the initiative and to maintain their involvement across an extended period of time. Results showed that there were 3 categories of positive outcomes associated with leading a walking club: maintaining and improving health, personal satisfaction, and group motivation. Difficulties associated with directing the club included high participant turnover rates, isolation of club directors, and lack of support from community organizations. Club directors indicated that sustainability would be enhanced through developing individual competencies, becoming more proficient at leading group dynamics, and developing better rootedness in the community. This information is interpreted in light of the six factors associated with sustainability.